In June 2009, Tonia Bass lost two things: her job and her health insurance. She had a variety of health issues and a collection of prescriptions to go with them -- between 12 and 15 at any given time, including vitamin supplements.

Bass is part of a growing patient population: those who take medications to manage two or more chronic conditions. Many of these patients have more than one prescriber, as well, which can create risk for drug-related problems caused by polypharmacy -- medications prescribed with no indication, adverse drug interactions, duplicate drug therapy, and non-adherence to treatment regimens.

Bass was able to participate in Project Access of Durham County, a program that connects uninsured patients receiving care at Lincoln Community Health Center (LCHC) to a local network of Duke specialists and others who donate specialty care.

In August 2008, the LCHC Pharmacy was accepted by a federal agency into a project focusing on medication reconciliation for patients in Project Access -- with the end goal of helping caregivers better understand patients’ medication needs, avert potential drug interactions, and make sure patients can obtain the drugs they’ve been prescribed and follow through on taking them.

Through this project, Project Access went from having a current, comprehensive medication list for only about 20 percent of its patients to 100 percent. “The key to our success was having a single point of accountability for all the services we were providing to Project Access patients,” says Duke’s Lynn Robbins, PharmD, project leader. “we designated a pharmacy care coordinator who makes absolutely sure that every service is provided for our patients.”

Duke University Hospital achieves the same single-source accountability by using electronic prescribing as its single central repository for drug ordering, says Philip Rodgers, PharmD, director of pharmacy education at Duke Area Health Education Center.

The health system also deploys Duke pharmacists into Duke clinic settings, such as primary care clinics, where the risk for errors and adverse effects related to polypharmacy can be high.

“We provide doctors and nurses with medication review and assist them in problem-solving,” he says, adding that there are also pharmacists based in Duke’s anticoagulation, lipid, and certain oncology clinics. “We are exploring opportunities to possibly deploy pharmacists to other clinics, such as transplant and other oncology areas.”

Three Ways Clinicians Can Help

Although patients are responsible for keeping providers informed about the medications they are taking, Philip Rodgers, PharmD, says there are three steps clinicians can take to help create an accurate medication list:

1. Acknowledge the medication information you have at hand is probably not completely accurate.
2. Conduct a thorough medication reconciliation review with the patient to prevent duplicate therapy or adverse drug interactions.
3. Call the patient’s pharmacy to get a list of medications other providers have prescribed and what medications the patient has been picking up.